title: Posterior retroperitoneoscopic adrenalectomy: preferred technique for removal of benign tumors and isolated metastases.
abstract: OBJECTIVE
  Posterior retroperitoneoscopic adrenalectomy (PRA) is a minimally invasive approach to removal of the adrenal gland. This anatomically direct approach, popularized by Walz, minimizes dissection and affords early access to the adrenal vein. We report the largest experience to date of PRA in the United States.
  
  
  METHODS
  The prospective endocrine surgery database at a tertiary care center was used to capture all patients who underwent PRA between October 2005 and February 2008. All PRA procedures were performed using a 3-trocar technique with the patient in a prone jackknife position.
  
  
  RESULTS
  Sixty-eight PRAs were performed in 62 patients; there were 6 conversions (3 video-assisted and 3 open). Indications for adrenalectomy were functional tumors in 43 patients (20 pheochromocytomas, 13 Cushing disease or syndrome, and 10 others), nonfunctional cortical adenomas in 4, and isolated adrenal metastases in 15. Mean tumor size was 3.4 cm. Complications occurred in 11 patients (16%), with no perioperative deaths. In 34 (55%) patients, there was a relative contraindication to an anterior approach. Additionally, 20 patients (38%) had a body mass index greater than 30. Median operating time was 121 minutes.
  
  
  CONCLUSIONS
  PRA is safe, avoids intra-abdominal adjacent organ mobilization, is unaffected by the presence of intra-abdominal adhesions, and is possible in obese patients. PRA may be the preferred technique for removing benign adrenal tumors and isolated metastases.
authors.affiliation: Department of Surgical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX 77030, USA. nperrier@mdanderson.org
authors.forename: Nancy D
authors.initials: ND
authors.lastname: Perrier
authors.forename: Debra L
authors.initials: DL
authors.lastname: Kennamer
authors.forename: Ruijun
authors.initials: R
authors.lastname: Bao
authors.forename: Camilo
authors.initials: C
authors.lastname: Jimenez
authors.forename: Elizabeth G
authors.initials: EG
authors.lastname: Grubbs
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Lee
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Evans
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000556:secondary / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011446:Prospective Studies; D012187:Retroperitoneal Space / Q000601:surgery*; D016896:Treatment Outcome